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Objective  To assess the current state of knowledge for the utility of coronary calcium scoring ( CCS ) in connective tissue disorders ( CTD s) as it relates to the presence and quantification of coronary atherosclerosis.    Methods  Following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses ( PRISMA ) guidelines, a literature search via PubMed, Embase, Scopus, Web of Science Core Collection,  CINAHL , and Cochrane Database of Systematic Review retrieved 1019 studies (since database inception on May 7, 2018) from which 121 manuscripts were eligible for review. Inclusion criteria consisted of studies that investigated  CCS  in adults with respective  CTD s. Studies were excluded if a complete manuscript was not written in English or was a case report.    Results  Thirty‐one studies were included (27 with healthy age‐/gender‐matched control group for comparison and 4 without).  CTD s analyzed in articles with control group: 11 rheumatoid arthritis ( RA ), 14 systemic lupus erythematosus ( SLE ), 4 systemic sclerosis ( SS c), 1 idiopathic inflammatory myopathies ( IIM ), 1 Takayasu arteritis, and 1 psoriasis. Nine out of 11  RA  studies, 12 out of 14  SLE  studies, and 2 out of 4  SS c studies showed statistically significant increased  CCS  when compared with the control group.  CTD s analyzed in studies without control group: two Kawasaki disease, one juvenile idiopathic arthritis ( JIA ), and one antiphospholipid syndrome ( APS ) article, which demonstrated increased coronary arterial calcium burden, however, without statistically significant data.    Conclusion   CTD s, especially  SLE  and  RA , are associated with higher  CCS  compared with the control group, indicating increased risk of coronary atherosclerosis. Our search did not elicit sufficient publications or statistically significant results in many other  CTD s.

acr open rheumatology

Utility of Coronary Calcium Scoring ( CCS ) in Connective Tissue Disorders ( CTD s) for the Evaluation of Subclinical Coronary Atherosclerosis – A Systematic Review